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1) to map questions of pain from a survey to the International Classification of Functioning, Disability and Health (ICF) 2) to compare the impact of musculoskeletal pain on functioning based on the different components of the ICF in children with juvenile idiopathic arthritis (JIA) and age-matched peers. A cross-sectional case-control survey. A total of 28 children with JIA and 36 age-matched children participated. The survey included questions on the child's sex and age, about pain experienced, number of painful body areas, pain frequency and three short forms of Patient-Reported Outcome Measurement Information System (PROMIS) pain questionnaires. Sixteen children with JIA (57%) and 10 peers (28%) reported pain during past seven days. Their responses were used in the description of impact of pain. After the mapping of the questions to ICF, a comparison between the two groups indicated that a higher number of children with JIA described effects of pain on mental function, mobility, general tasks and demands, than their peers. More children with JIA expressed to others that they had pain, non-verbally and verbally. The findings provide important information about the impacts of pain on daily life in children with JIA and about their intervention needs. [ABSTRACT FROM AUTHOR]

To understand and discuss the perceptions about fear of falling (FOF) in older adults without a history of falls. A qualitative study with a convenience sample consisting of 51 older adults. Data collection was out through semi-structured interviews during the Covid-19 pandemic. Data were analyzed using thematic analysis. Three themes were grouped: FOF and its repercussions; Reactions to FOF in the daily life of the pandemic; and No fear, but aware of aging. The older adults reported a fear of dependence, difficulties and cautious behaviors in activities of daily living and mobility in the community. Understanding FOF can contribute for your approach and building multidisciplinary and intersectoral strategies aimed at maintaining independence and strengthening the identity of older adults without a history of falls in the community. [ABSTRACT FROM AUTHOR]

Older patients with lower limb amputation, categorised as having "limited community mobility", are under-researched. Understanding their experience with a new prosthetic ankle-foot is important when designing clinical trials. The aim of this qualitative study was to explore the adjustments they made after amputation and the acceptability of a self-aligning ankle-foot (SA-AF) to older adults. Fourteen participants, who took part in the STEPFORWARD randomised controlled feasibility trial (ISRCTN15043643), were purposively recruited; nine were intervention participants and five were standard care participants. They were asked to reflect on their life prior to and consider the adjustments they made following their amputation. Participants in the intervention group were also asked about their views of the new SA-AF compared to their standard non-SA-AF. A thematic analysis was undertaken. Three broad themes were identified: The impact of the amputation; Role of clinical support; and Experiences of the SA-AF. The findings tell a narrative of the long-term impact that amputation has on these individuals' lives. Participants randomised to receive the SA-AF were very positive about it, reporting less pain, greater mobility and being able to do more. Participants who used the SA-AF found it an acceptable intervention. These findings suggest that a full-scale RCT is warranted. There is a high degree of acceptability among an older patient group with a transtibial amputation to use a self-aligning ankle foot. Patients reported experiencing better mobility and more prosthetic comfort with the self-aligning ankle-foot. Key outcomes important to participants include engagement in social and daily activities and balance confidence. [ABSTRACT FROM AUTHOR]

Stroke is the leading cause of disability worldwide. Assessing stroke's impact on patients' daily activities and social participation can provide important complementary information to their rehabilitation process. However, no previous study had been conducted on the psychometric properties of the Brazilian version of the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) in the stroke population. This study aimed to examine the internal consistency, test-retest and inter-rater reliability, convergent validity and floor/ceiling effect of the Brazilian version of the WHODAS 2.0 in individuals after chronic stroke. Two examiners interviewed 53 chronic stroke individuals who responded to the Brazilian 36-item version of the WHODAS 2.0 three times to analyze test-retest and inter-rater reliabilities. Floor/ceiling effects were calculated as relative frequencies of the lowest or the highest possible WHODAS 2.0 scores. Participants also responded to the Stroke Impact Scale 3.0 (SIS 3.0) and the Functional Independence Measure (FIM) to analyze convergent validity. The internal consistency analyses for domains of WHODAS showed a strong correlation among the items of each domain (0.76–0.91) except for the "getting along" domain, which presented a moderate correlation (ρ = 0,62). Total scores of WHODAS 2.0 showed satisfactory internal consistency (α = 0.93), good inter-rater reliability (ICC = 0.85), excellent test-retest reliability (ICC = 0.92) and no significant floor/ceiling effect. Convergent validity indicated moderate to strong correlations (ρ=-0.51 to ρ=-0.88; p < 0.001), with the highest values associated with the correlation with the SIS scale. The Brazilian version of the WHODAS 2.0 instrument presented evidence of reliability and validity for chronic post-stroke individuals. [ABSTRACT FROM AUTHOR]

To examine the experience of people with Parkinson's disease when walking in different social situations, and improve understanding of how this affects participation in meaningful activity. A convenience sample of fourteen people with Parkinson's disease and a history of gait dysfunction was recruited. In-depth interviews and direct observations were conducted in the participants' home environments. Specific examples from community mobility were reviewed using first person interviewing techniques with the support of video footage. Interview transcripts were analyzed using an interpretive phenomenological approach to derive key themes. The feeling of 'being looked at' (le regard des autres) was the central theme in participant discourse. This sentiment was inextricably linked to the given norms of the social setting, and the relationships between participants and others within that environment. Participants sought to manage how they were perceived by others through modification of posture/gait patterns; disclosure of their neurological disease; and avoidance/withdrawal from social situations. Further to the functional aspects of mobility, gait is important for maintaining self-image in people with Parkinson's disease. Affective gaze interactions have significant consequences upon participation restriction. These findings underscore the interest of activities which strengthen self-image and validate movement diversity in PD rehabilitation. [ABSTRACT FROM AUTHOR]

Standing power wheelchairs (PWSDs) expand positioning and mobility options for individuals with motor impairments. Although more available, little is known about how PWSDs are used in everyday life. to describe children's use of PWSDs in the first three months post-wheelchair delivery and the impacts on satisfaction with participation in daily life. An interrupted time series of purposefully sampled children aged 5–18 years who were receiving a PWSD. The Wheelchair Outcome Measure for Young People (WhOM-YP) documented satisfaction with patient-reported meaningful participation outcomes. Data loggers objectively measured wheelchair mobility outcomes including distance travelled, bouts of mobility, and duration. Data were measured over two sessions pre-wheelchair-delivery and at one week, one month and three months post-wheelchair-delivery. Six children aged 7–18 years participated, four diagnosed with cerebral palsy, two with spina bifida. Analyses of individual data illustrated positive change in overall WhOM-YP satisfaction scores after PWSD provision though change varied across time, as did, distance, bouts of mobility and duration of use. Participants identified 14 in-home and 16 out-of-home unique participation outcomes, although several commonalities existed. PWSDs hold promise for increasing children's satisfaction with participation in daily life, in addition to possibly increasing mobility outcomes. For children with mobility limitations, PWSDs may promote participation in daily life and increased mobility. Data logger technology provides valuable information about children's PWSD use and how this varies over time. Benefits and challenges exist with implementing PWSD and data logger technologies. When implementing PWSD use, it is critical to consider context, training and support needs of clients and caregivers. [ABSTRACT FROM AUTHOR]

The activities of daily life (ADL) of stroke patients generally improves after rehabilitation. However, some patients remain at risk of ADL deterioration in the future. So far, there have been few studies on the factors related to ADL deterioration in stroke patients. To identify the factors related to ADL deterioration in stroke patients with independent mobility after discharge. We assessed 336 stroke patients with independent mobility who were discharged from the rehabilitation center between January 2016 and December 2018. The primary outcome was ADL deterioration, defined as that ADL assessed at 2 years after discharge decreased more than 15 points compared with that assessed at discharge. Univariate and multivariate statistical analyses were conducted to screen for factors related to ADL deterioration. Overall, 62 (18.4%) patients exhibited ADL deterioration at 2 years after discharge. Age (OR = 1.114, 95%CI = 1.045–1.188, p = 0.001), vascular risk factors>3 (OR = 3.269, 95%CI = 1.189–8.986, p = 0.022) and with post-stroke depression (OR = 2.486, 95%CI = 1.011–6.114, p = 0.047) were risk factors for ADL deterioration in stroke patients. In contrast, elevated Berg Balance Scale (BBS) scores at discharge was a protective factor for ADL deterioration (OR = 0.484, 95%CI = 0.386–0.606, p < 0.001). Nearly 1 in 5 stroke patients with independent mobility experienced ADL deterioration at 2 years after discharge. Aging, vascular risk factors>3, BBS at discharge, and post-stroke depression (PSD) were identified as factors associated with ADL deterioration [ABSTRACT FROM AUTHOR]

This longitudinal case study describes the physical and occupational therapy interventions and recommendations for treatment of a person with bilateral transradial amputations during subacute rehabilitation, as there are currently few recommendations. A 53-year-old female with subacute bilateral transradial amputations received inpatient rehabilitation. Impairments include decreased balance, global weakness, and need for assistance with ADLs and transfers. Physical therapy, occupational therapy, nursing, a peer mentor, and a prosthetist collaborated. Interventions included task-specific and generalized strengthening, standing balance re-education, assistive device prescription, education using body-powered prostheses, home adaption recommendations, and activities of daily living practice. Patient progressed to independent functional mobility but required assist for activities of daily living and stairs negotiation due to limited caregiver support and poor prosthetic dexterity. She discharged to a skilled nursing facility. Rehabilitation of a person with bilateral transradial amputations requires clinicians experienced with prostheses; excellent interdisciplinary coordination; early discernment of the available social support system; task-specific strengthening and coordination exercises to prepare the patient for prostheses; significant task-practice with prostheses; and a working knowledge of home modifications and adaptive equipment. This article describes recommendations, successful interventions, and lessons learned for future therapists when rehabilitating someone with bilateral transradial amputations. Bilateral transradial amputations (BTAs) are a life-altering, but rare condition, meaning that literature surrounding this population is sparse and that guidelines for rehabilitation are unclear. This article provides recommendations so that clinicians can be better informed when treating BTA patients in the subacute phase and more quickly progress patients toward functional independence and discharge to the community. [ABSTRACT FROM AUTHOR]

To investigate the intra-rater reliability and the construct validity of the Turkish version of the De-Morton Mobility Index (DEMMI) in intensive care unit (ICU) survivors. Construct validity of the DEMMI was measured by correlating it with physical functioning scales. Known group comparison was made according to the Medical Research Council Sum Score (MRC-SS). Internal consistency was determined by measuring Cronbach α coefficient. Test-retest reliability was assessed by performing the DEMMI by the same researcher after 24 h and calculating the intraclass correlation coefficient (ICC). The minimal detectable change (MDC) value was calculated. One hundred and two patients discharged from the ICU were included. The ICC for intra-reliability was 0.972. The internal consistency was excellent (Cronbach = 0.991). The DEMMI total score was correlated with the Barthel Index (r = 0.791), Katz Index of Independence in Activities of Daily Living (r = 0.722), MRC-SS (0.614), ICU length of stay (r = –0.515), and total mechanical ventilation duration (r = –0.488). The DEMMI was able to differentiate between MRC-SS subgroups (p < 0.001), whereby higher strength was associated with higher DEMMI scores. The MDC was determined to be 6.82 out of 100 points. The Turkish version of the DEMMI is reliable and valid for measuring mobility in ICU survivors. NCT05196997 The Turkish version of the de-Morton Mobility Index (DEMMI) is a reliable and valid outcome measure for the assessment of functional mobility in intensive care unit survivors. The Turkish version of the DEMMI could guide clinicians working in the field of intensive care in the planning of rehabilitation programs after discharge. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) is a major cause of childhood disability. Children with CP often lack motor skills to effectively perform activities of daily living. The aim is to assess the effectiveness of a functional intensive therapy program focused on improving individual goals in the domain of mobility and self-care in children and adolescents with CP. Thirty-five CP patients, aged 11–19 years, GMFCS I–IV, received daily 6–7 h of functional therapy for 15 days. Outcomes were assessed at baseline, immediately after the program and at three months follow-up. Significant post-intervention improvement was seen on all primary and secondary outcome measures; personal goals (GAS score; COPM performance and COPM satisfaction), daily activities (ACTIVLIM), hand function (ABILHAND-Kids), mobility (ABILOCO-Kids; GMFM-66-IS score). There was no loss to follow up during the program and after three months. At follow-up, improvements were retained except for ABILOCO and GMFM-66-IS. Functional intensive therapy appears feasible and seems to be effective in improving treatment goals focused on mobility and self-care, even in older and more severely affected children and adolescents with CP. After three months, these possible effects were still present. Short intensive functional training is feasible and showing no loss to follow up in the older and more severely affected children and adolescents with cerebral palsy (CP). Short intensive functional training appears effective in improving individual goals in children and adolescents with CP and improvements endorse three months. Short intensive functional training seems to be effective on both mobility and self-care domains of the ICF-CY. [ABSTRACT FROM AUTHOR]

Informal caregivers of stroke survivors often report the need for training on how to care for a loved one with functional mobility limitations. Evidence on training interventions to help informal caregivers with issues related to mobility is varied. The objective of this scoping review was to examine the literature including skill-based training interventions that educate caregivers on functional mobility for stroke survivors. We extracted studies from OVID Medline, Cochrane, ISI Web of Knowledge, and Embase published between 1990 and 2021. At every stage of assessment, data extraction forms were used to reach consensus among at least three out of four authors. We followed PRISMA-ScR guidelines and Arskey and O'Malley's framework to chart information into several tables based on research questions and summarized with descriptive statistics. Most studies were conducted outside the US focused on training in mobility and activities of daily living. The stroke survivor, on average, was an older individual (mean age 64.8 [SD = 5.3] years). The informal caregiver was predominately a younger female spouse (mean age 54.2 [SD = 6.3]). More than a third of the studies reported improvement in the stroke survivors' physical function post-intervention, with a mean follow-up time of 4.4 months. Effective studies tended to include stroke survivors with less cognitive and functional mobility limitations at higher training dosages. Gaps in our understanding of informal caregiver training for those caring for stroke survivors are identified, and recommendations are provided for future research. [ABSTRACT FROM AUTHOR]

As age-related changes progress, individuals with long-term mobility disabilities experience more challenges in engaging with everyday activities. This archival analysis identified common activity challenges older adults with long-term mobility disabilities report and the type of strategies they employed to respond to these challenges, using the interview data (n = 60) from the Aging Concerns, Challenges, and Everyday Solution Strategies Study. We discovered that activity challenges come from intrinsic factors (i.e., mobility limitations, strength, health conditions) as well as extrinsic factors (transferring and physical access). With these challenges in mind, we constructed home environment design strategies that could meet the needs of people aging with mobility disabilities. [ABSTRACT FROM AUTHOR]

To investigate the effect of physical exercise on body structure & function and activity outcomes in individuals with Mild Cognitive Impairment (MCI). Six databases were searched from inception until January 2021. Randomized controlled trials (RCTs) comparing physical exercise with a control group were included. Fourteen RCTs were included. Three types of physical exercise were identified: aerobic (AE), resistance (RE), and multimodal (ME). Regarding body structure & function outcomes, evidence for RE was very low and with effect for improvement in upper limb muscle strength and very low and without effect for lower limbs. For improvement in postural balance, evidence was very low and with effect with AE and very low and without effect with RE and ME. Evidence for cardiorespiratory function was very low and without effect with AE and RE. Regarding activity outcomes, evidence was low and without effect for mobility with AE and very low and without effect with RE and ME. Physical exercise promoted improvements in body structure & function outcomes in individuals with MCI. Resistance exercise improvement upper limb muscle strength and AE enhanced postural balance. In contrast, physical exercise did not promote a significant benefit in activity outcomes. Results of this systematic review have shown that physical exercise promoted improvements in body structure & function outcomes in individuals with Mild Cognitive Impairment (MCI). Resistance exercise with elastic bands for approximately 60 minutes twice a week for a total of three months improved upper limb muscle strength. Aerobic exercise with walking for approximately 60 minutes twice per week for a total of six months enhanced postural balance. Considering the potential benefits identified in this systematic review, physical exercise can be recommended for individuals with MCI. We also highlight the importance of the use of the International Classification of Functioning, Disability and Health for rehabilitation planning. [ABSTRACT FROM AUTHOR]

This study aimed at establishing the impact of community-based rehabilitation (CBR) on the physical functioning and activity of daily living (ADL) of patients with stroke (PWS). Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was conducted in five databases, including PubMed, OVID Embase, OVID Medline, Cochrane Library, and Web of Science between May 2010 and 2020. Meta-analysis was performed using the Comprehensive Meta-Analysis Version 2 software to establish whether the studies were sufficiently homogenous. Twenty studies out of 828 publications were included in the present systematic review. A significant difference between CBR intervention and control groups was identified about the physical functional capacity in mobility, 6-metre walk test (6MWT) (g = 0.351, 95% CI (0.110, 0.592)), community walking test (g= −0.473, 95% CI (−0.926, −0.020)) and on the other hand a significant improvement in ADL was found (g = 0.138, 95% CI(0.051, 0.224)). CBR is revealed to be effective in improving the physical functioning and ADL for PWS and is drawn based on eligible studies which were conducted in high-income countries (HICs). This highlights a gap between developed and less-resourced countries as far as CBR for PWS is concerned and calls for a further study. Protocol Registration: CRD42020159683 Community-based rehabilitation (CBR) is recommended as one of the best programme for treating stroke patients with stroke (PWS) after they are discharged from hospitals. CBR is effective in improving the physical functioning and activity of daily living of PWS. Further research should be carried out to compare between CBR and institution-based rehabilitation for PWS, especially the less-resourced settings which are grappling with a challenge of limited skilled rehabilitation professionals. [ABSTRACT FROM AUTHOR]

Determine whether race predicts fear of falling (FOF) in older adults with a history of previous fall(s) while controlling for mobility performance, activity of daily living (ADL) independence, age, gender, and education. We examined predictors of FOF among community-dwelling older adults using data from two longitudinal randomized controlled trials that implemented fall prevention programs for community-dwelling older adults. Two hundred fifty-nine participants were included in the analysis; 145 reported low FOF, while 59 reported high FOF. After controlling for mobility performance, ADL independence, and sociodemographic factors, Black older adults were more likely to report FOF (OR = 2.17) compared to White older adults. Overall, older adults with lower mobility performance/functioning scores were more likely to have FOF (OR = 0.08). Older adults (aged ≥65 years) who are at higher risk, based on a prior history of fall(s), are more susceptible to developing FOF, as evidenced by the older adults within this study, due to limited mobility performance and functioning. Black older adults may be at greater risk of FOF than their White counterparts based on previous fall history and level of functional mobility. Incorporating measures of objective performance-based function along with measures of psychological factors are viable methods to identify and address FOF within Black older adult populations. [ABSTRACT FROM AUTHOR]

To identify longitudinal changes in life-space mobility and the factors influencing it among chronic, stable post-stroke patients. This prospective study included Japanese post-stroke patients who received day-care rehabilitation services and could undergo three life-space mobility assessments (at baseline, 12, and 24 months) for over 2 years, using the Life-Space Assessment (LSA) tool. Physical function, cognitive function, and activities of daily living were assessed by self-selected comfortable gait speed, Mini-Mental State Examination (MMSE), and Functional Independence Measure Motor subscale (FIM motor) scores, respectively, in addition to age, sex, time from onset, stroke type, and comorbidities. A multivariable linear mixed-effects model was used to examine the longitudinal changes in LSA scores and associated factors. A total of 89 participants were enrolled. At baseline, the median age was 74 years, 33% were women, and median time from onset was 75 months. The LSA scores significantly declined over the two-year period. In the multivariate linear mixed-effects model adjusted for clinical characteristics, comfortable gait speed and age were significantly associated with changes in the LSA score, independent of FIM motor scores and MMSE scores. Life-space mobility may persistently decline, and gait function may be a determinant influencing these changes in community-dwelling chronic post-stroke patients. Limited life-space mobility leads to less frequent participation in social activities and an increased risk of adverse health outcomes such as hospitalization. Changes in life-space mobility should be considered in the rehabilitation care plan for chronic post-stroke patients. Life-space mobility may decline persistently in stable post-stroke patients, even if they have periodically received day-care rehabilitation services. Since gait speed is a predominant factor affecting life-space mobility, regular assessment of gait function and appropriate strategies are needed to prevent deterioration of gait speed in chronic post-stroke patients. [ABSTRACT FROM AUTHOR]

To test validity and responsiveness of Traffic Light System-BasicADL (TLS-BasicADL). Validity: Data according to TLS-BasicADL, modified Functional Independence Measure (FIM) and Barthel Index (BI) were collected from 50 patients with mixed medical diagnoses. Responsiveness: 106 patients following hip fracture assessed according to TLS-Basic ADL and modified Katz Index. Percentage change in TLS-BasicADL from pre-fracture status, to post-operatively, discharge and 1 month follow-up was calculated. TLS-BasicADL and modified Katz Index were also correlated at discharge and 1 month. For analysis of responsiveness, Spearman's rho coefficient (rs) was used and for distribution at item level, percentage change and sign test. Validity: Strong-excellent correlations between TLS-BasicADL and modified FIM (0.65–0.95), TLS-BasicADL and modified BI (0.77–0.97) for individual items. Analysis of total scores revealed excellent correlations between instruments (0.96–0.98). Responsiveness: Significant differences between assessments for each item of TLS-BasicADL except upper hygiene, dressing and eating. Excellent correlation was found between TLS-BasicADL and modified Katz Index between pre-fracture – discharge (0.897) and moderate-strong (0.597) discharge − 1 month. TLS-BasicADL is shown to have acceptable concurrent validity for measuring basic mobility and self-care in elderly patients with mixed medical diagnoses and responsive for patients following hip fracture surgery. Investigation of responsiveness is registered in ClinicalTrials.gov Identifier: NCT03301584 (Retrospectively registered: 4th October 2017). Traffic Light System-BasicADL (TLS-BasicADL) provides a simple assessment scale that highlights level of independence in basic activities of daily living. TLS-BasicADL gives the multi/inter-disciplinary team a baseline showing the persons previous and present level of function and visual aid for discussing rehabilitation goals and need for future care. TLS-BasicADL is shown to have acceptable concurrent validity for measuring basic mobility and self-care in elderly patients with mixed medical diagnoses and responsive for patients following hip fracture surgery. [ABSTRACT FROM AUTHOR]

Individuals with dual cancer and spinal cord injury diagnoses present unique challenges to rehabilitation teams. This case report describes the modification of a physical therapy plan of care for an individual with incomplete spinal cord injury (iSCI) resulting from metastatic lung cancer who underwent adjunctive cancer treatment. A 61-year-woman with small cell lung cancer and T5 iSCI presenting to inpatient rehabilitation (IPR) to address function limitations from iSCI following metastatic epidural tumor resection. Interventions focused on task-specific training of mobility skills with modifications made to address cancer-related fatigue, promote energy conservation, and prioritize functional skills for home discharge given anticipated disease progression. IPR length of stay was 31 days. Functional Independence Measure (FIM) total score increased from 52/133 at admissions to 106/133 at discharge. Spinal Cord Independence Measure – III (SCIM-III) total score increased from 31/100 to 55/100. Functional Assessment of Chronic Illness Therapy-Fatigue Subscale score increased from 21/52 to 41/52 reflecting reduced fatigue level compared to admission. These gains facilitated discharge home with family support. Physical therapy plan of care required consideration of dual diagnosis, cancer-related fatigue, and patient-centered goals. Participation in IPR positively affected quality of life and ability to return home with family. [ABSTRACT FROM AUTHOR]

To summarise existing systematic reviews which assessed the effects of physical exercise on activities of daily living, walking, balance and visual processing in people with dementia or mild cognitive impairment In this overview of systematic reviews and meta-analyses, seven electronic databases were searched to identify eligible reviews published between January 2015 and April 2021. A total of 30 systematic reviews were identified and included in the overview. The most frequent type of exercise for the intervention group was multimodal exercises. Mind-body exercises, exergames, dance intervention and aerobic exercise were other exercise types. Most of the reviews reported that exercise is significantly effective for improving activities of daily living (SMD 95%CI, from 0.27 to 1.44), walking (SMD 95%CI, from 0.08 to 2.23), balance (SMD 95%CI, from 0.37 to 2.24) and visuospatial function (SMD 95%CI, from 0.16 to 0.51), which are among the most leading determinants of independent living in individuals with dementia or mild cognitive impairment. Evidence has shown that exercise (especially multicomponent exercise programmes including cognitive, physical and multitasking exercises) with sufficient intensity improves the activities of daily living skills. Exercise also improves walking, balance and visual processing, which can provide a more independent life for people with dementia and mild cognitive impairment. Cognitively impaired people should therefore be encouraged to exercise regularly in order to be more independent. Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2019192 [ABSTRACT FROM AUTHOR]

Arthritis is a common chronic condition in the ageing population. Its impact on physical function varies according to sociodemographic and race/ethnic factors. The study objective was to examine the impact of arthritis on physical function and disability among non-disabled older Mexican Americans over time. A 23-year prospective cohort study of 2230 Mexican Americans aged 65 years and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94–2016). The independent variable was self-reported physician-diagnosed arthritis, and the outcomes included Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Short Physical Performance Battery (SPPB), and handgrip strength. Covariates were sociodemographic, medical conditions, body mass index, depressive symptoms, and cognitive function. General linear mixed models were performed to estimate the change in SPPB and muscle strength. General Equation Estimation models estimated the odds ratios (OR) of becoming ADL- or IADL- or mobility – disabled as a function of arthritis. All variables were used as time-varying except for sex, education, and nativity. Overall, participants with arthritis had higher odds ratio (OR) of any ADL [OR = 1.35, 95% Confidence Interval (CI) = 1.09–1.68] and mobility (OR = 1.34, 95% CI = 1.18–1.52) disability over time than those without arthritis, after controlling for all covariates. Women, but not men, reporting arthritis had increased risk for ADL and mobility disability. The total SPPB score declined 0.18 points per year among those with arthritis than those without arthritis, after controlling for all covariates (p-value <.010). Our study demonstrates the independent effect of arthritis in increasing ADL and mobility disability and decreased physical function in older Mexican Americans over 23-years of follow-up. [ABSTRACT FROM AUTHOR]

To determine which factors are associated with physical inactivity in hospitalized adults of all ages. A cross-sectional sample of 114 adults admitted to a gastrointestinal surgery, internal medicine or cardiology hospital ward (median age 60, length of stay 13 days) were observed during one random day from 8 am to 8 pm using wireless accelerometers and behavioral mapping protocols. Factors (e.g., comorbidities, self-efficacy, independence in mobility, functional restraints) were collected from medical records, surveys, and observations. Patients were physically active for median(IQR) 26 (13–52.3) min and were observed to lie in bed for 67.3%, sit for 25.2%, stand for 2.5%, and walk for 5.0% of the time. Multivariable regression analysis revealed that physical inactivity was 159.87% (CI = 89.84; 255.73) higher in patients dependent in basic mobility, and 58.88% (CI = 10.08; 129.33) higher in patients with a urinary catheter (adjusted R2 = 0.52). The fit of our multivariable regression analysis did not improve after adding hospital ward to the analysis (p > 0.05). Independence in mobility and urine catheter presence are two important factors associated with physical inactivity in hospitalized adults of all ages, and these associations do not differ between hospital wards. Routine assessments of both factors may therefore help to identify physically inactive patients throughout the hospital. Healthcare professionals should be aware that physical inactivity during hospital stay may result into functional decline. Regardless of which hospital ward patients are admitted to, once patients require assistance in basic mobility or have a urinary catheter they are at risk of physical inactivity during hospital stay. Implementing routine assessments on the independence of basic mobility and urine catheter presence may therefore assist healthcare professionals in identifying physically inactive patients before they experience functional decline. [ABSTRACT FROM AUTHOR]

Yoga may be a beneficial treatment for people with Parkinson's disease (PD). However, no studies have critically reviewed and meta-analyzed the scientific evidence for yoga's benefits regarding motor and non-motor symptoms. The purpose of this study was to conduct a systematic review and meta-analysis on the effectiveness of yoga as a rehabilitation strategy for PD. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was performed using MEDLINE/PubMed, PEDro, SPORTDiscus, and Scopus. Studies addressing any concepts on the impact of yoga intervention on physical and psychological outcomes in people with PD were included. Fourteen RCTs were selected, with heterogeneous protocols and outcomes measures. Yoga interventions were safe and well-accepted for patients with mild to moderate PD. The descriptive analysis indicated that its practice might provide both physical and psychological benefits. Preliminary evidence showed that yoga has comparable or superior efficacy to exercise. A subsequent meta-analysis on five RCTs detected that yoga was more effective than passive control in ameliorating motor symptoms. Yoga appears to be a promising rehabilitative therapy for individuals with PD. Recommendations are proposed for future studies. Yoga is a safe and feasible therapy for people with mild to moderate PD. Yoga practice positively impacts physical and mental health in this population. When compared to exercise, yoga showed to have similar or even greater effects. [ABSTRACT FROM AUTHOR]

To explore spouses' experiences of the value of mobility scooters prescribed to their partner. A descriptive design with a qualitative approach was used. Thirteen spouses (11 females) aged 65–86 years participated. Semi-structured interviews were conducted when the spouse's partner had had the mobility scooter for 4–6 months. The interviews were analysed using qualitative content analysis. The interviews showed primarily that the spouses experienced that their everyday lives and life situation had improved since their partner had received a mobility scooter. They reported that they could engage in activities of their own choice to a greater extent. The prescription of a mobility scooter to their partner had also yielded a sense of freedom related to shared activities. On the other hand, the spouses described some of the scooter's limitations. Three categories emerged: a sense of freedom related to the spouse's own activities, a sense of freedom related to shared activities and a somewhat restricted freedom. Prescription of a powered mobility scooter was of value to the users' spouses because it facilitated independent and shared activities and participation in the community. The value was mainly expressed as a sense of freedom when doing things on their own or together with their partner. Spouses are key persons in the rehabilitation of people with mobility restrictions. Their views on the assistive device may influence the rehabilitation process. Knowledge of spouses' experiences is thus crucial, as this may influence the future rehabilitation outcome. A powered mobility scooter prescribed to one partner eases everyday life and increases activity and participation for the spouse, which in turn may further improve the quality of life for the scooter user. The spouses' perspectives on their partners' mobility scooter use could be helpful in developing the design of the mobility device and in the prescription process. A mobility scooter has an added value by giving a sense of freedom and freedom to choose for the spouse as well as the scooter user. [ABSTRACT FROM AUTHOR]

COPD fits the profile of disabling health conditions. This study aims to validate the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in individuals with COPD. 100 participants with COPD responded to the Brazilian 36-item version of the WHODAS 2.0, as well as the Saint George's Respiratory Questionnaire (SGRQ), and the COPD Assessment Test (CAT). Spirometric data was extracted from medical records. The internal consistency analysis showed coefficients for all WHODAS 2.0 domains with a strong correlation (0.70–0.85) except for Life activities, which had a moderate correlation (coefficient = 0.60). In the construct analysis, the coefficients for the WHODAS and SGRQ domains presented a consistent correlation among them, varying from 0.40 to 0.69. No correlation was evidenced among the WHODAS domains and the spirometric data, highlighting that linear measures fail when associated with the functioning of an individual with COPD. Discriminative analysis revealed a capacity for the WHODAS 2.0 to distinguish among COPD different levels of clinical impact obtained from CAT excluding the Getting along domain. The WHODAS 2.0 shows as a valid instrument that can sensibly assess functioning differences related to the clinical impact classification level in subjects with COPD. WHODAS 2.0 is a valid tool to assess functioning in subjects with COPD. WHODAS 2.0 is sensitive to functioning differences related to classification level and to clinical impact in individuals with COPD. As a Patient-Reported Outcome Measure (PROM), WHODAS 2.0 offers the opportunity to develop clinical patient-centered interventions, improving the health care. As a low-cost, easy-to-use tool, WHODAS can be a useful resource in the process of clinical assessment of patient functioning. [ABSTRACT FROM AUTHOR]

Joubert Syndrome (JS) is a rare inherited neurodevelopmental disorder defined by a characteristic cerebellar and brainstem malformation (i.e. the molar tooth sign) and variable organ involvement. The aim of the present study was to describe functional limitations and disabilities in a large sample of adult patients with a diagnosis of JS. We administered the International Classification of Functioning (ICF) checklist to thirty-six adult Italian patients with JS or their caregivers through telephone calls. None-to-mild impairment was documented for basic cognitive and mental functions, whereas severe deficit emerged for higher-order skills and language. A mismatch between individuals' capacity for daily activity and social participation and the actual performance in these fields emerged, suggesting that adults with JS may greatly benefit from external support from the caring environment. Indeed, specific facilitators were highlighted, including communication technologies as well as family members, healthcare professionals and peers support. Mild-to-severe barriers have been identified by adult patients with JS in the domains of services, systems and policies. These findings highlight challenges and barriers for adults with JS in areas of daily functioning that may be improved by investing in rehabilitation care models that embed social support programs and policies into clinical interventions. Children with Joubert Syndrome, a child-onset rare inherited neurodevelopmental condition, are growing up and becoming adults; a life course approach in rehabilitation is needed; There is a substantial lack of information on the long-term adaptive daily functioning of children with a diagnosis of Joubert Syndrome; In this paper, the International Classification of Functioning (ICF) was applied to assess the daily functioning in people with JS; Severe deficits emerged for high-order skills and language, whereas the use of communication technologies and the engagement of family members were highlighted as key facilitators; These findings highlight the need for a change of paradigm in the care model of subjects with JS, with the embedding of social support in rehabilitation programs. [ABSTRACT FROM AUTHOR]

To examine the expectations of informal caregivers, nurses, and dementia trainers regarding the support of (physical and psychosocial) human needs by humanoid social assistive robots (SARs) in dementia care. A qualitative study was conducted with 11 homogeneous focus groups of informal caregivers, nurses and dementia trainers providing dementia care at home, in adult daycare centers, or in nursing homes. A qualitative content analysis was performed using a concept- and data-driven coding frame. Focus group discussions with 52 individuals were held. Participants reported mostly positive expectations and stated that SARs could offer potential support in all components of human needs, especially in avoiding danger (e.g. recognise danger, organise help), communication/contact with others (e.g. enable telephone calls, provide company), daily activities (e.g. remind of appointments, household obligations), recreational activities (e.g. provide music), eating/drinking (e.g. help cook), and mobility/body posture (e.g. give reminders/instructions for physical exercise). Participants also mentioned some negative expectations in all human needs, predominantly in communication/contact with others (e.g. loss of interpersonal interaction) and avoiding danger (e.g. scepticism regarding emergencies). Participants stated that SARs had great potential to provide assistance in dementia care, especially by reminding, motivating/encouraging and instructing people with dementia. Informal caregivers and nurses also considered them as useful supportive devices for themselves. However, participants also mentioned negative expectations, especially in communication/contact with others and avoiding danger. These findings demonstrate the support caregivers and dementia trainers expect from humanoid SARs and may contribute to their optimisation for dementia care. [ABSTRACT FROM AUTHOR]

After massive weight loss, the severe gynoid body contour deformities are not always faceable with optimal results. The thigh is one of the most demanding area to address; therefore, the approach should be virtually individualized. The authors describe the helix thigh lift: A novel technique that combines vertical with horizontal axis of pull. The goal of this ultimate customization is to dramatically impact physical functioning and esthetics of this patient population. Thigh lift patients from 2016 to 2019 were assessed retrospectively; fourteen patients were selected for helix thigh lift procedure. Preoperative markings, surgical technique and outcomes were described. The mean follow-up time was 14.8 ± 3.2 months. A questionnaire was administered to evaluate the results. Fourteen female patients (mean age, 42 ± 4.8 years) underwent helix thigh lift after massive weight loss. The overall complication rate was 36 percent. They were all minor complications and were treated in an outpatient setting. Seroma formation was the most frequent, at 29 percent. No skin necrosis was reported. Complication development was straight related to the age of the patient (p = 0.0455). The patients were very satisfied with the overall outcome. Helix thigh lift effectively addresses the severe gynoid body contour deformities. The high satisfaction and the reasonable complication rate suggest that this is a safe and effective technique. The age of the patient was significantly associated to complication development. A dramatic improvement of ease in performing activities of daily living along with reduction of the skin problems leads to significant improvement of the quality of life. [ABSTRACT FROM AUTHOR]

In this narrative review the potential and importance of handcycling are evaluated. Four conceptual models form the framework for this review; (1) the International Classification of Functioning, Disability and Health; (2) the Stress-Strain-Capacity model; (3) the Human-Activity-Assistive Technology model; and (4) the power balance model for cyclic exercise. Based on international handcycle experience in (scientific) research and practice, evidence-based benefits of handcycling and optimization of handcycle settings are presented and discussed for rehabilitation, daily life and recreational sports. As the load can be distributed over the full 360° cycle in handcycling, peak stresses in the shoulder joint and upper body muscles reduce. Moreover, by handcycling regularly, the physical capacity can be improved. The potential of handcycling as an exercise mode for a healthy lifestyle should be recognized and advocated much more widely in rehabilitation and adapted sports practice. The interface between handcycle and its user should be optimized by choosing a suitable person-specific handcycle, but mainly by optimizing the handcycle dimensions to one's needs and desires. These dimensions can influence efficient handcycle use and potentially improve both endurance and speed of handcycling. To optimize performance in rehabilitation, daily life and recreational sports, continued and more systematic research is required. Handcycling allows users to travel farther distances at higher speeds and to train outdoors. It should be recognized as an alternative exercise modality for daily outdoor use, also already in early rehabilitation, while it contributes to a healthy lifestyle. To individualize handcycle performance, the user-handcycle (assistive device) interface as well as the vehicle mechanics should be optimized to minimize external power and reduce friction, so that the upper body capacity can be efficiently used. To optimize handcycling individual performance, both the physiological and biomechanical aspects of handcycling should be considered when monitoring or testing handcycle exercise. [ABSTRACT FROM AUTHOR]

Our aim was to reach a better insight of the disposition of people living alone with dementia toward the use of care and support services. In biographical narrative interviews, women and men with dementia communicated to us their opinions, needs, and subjectively perceived level of resources regarding their everyday life and care. Both individual and gender-specific differences concerning the use of formal support become evident in their narrations. We offer indications for a future healthcare practice that is specific to dementia. To fully exploit the potential of participatory research, study designs specific to dementia should be developed further. [ABSTRACT FROM AUTHOR]

Background: Activities of daily living (ADL) are crucial for children because they enable them to participate in everyday life. For the evaluation of children s ADL performance, health professionals such as occupational therapists use standardized ADL assessments. To implement assessments into practice it is important that the score generated from an assessment can be viewed as a unidimensional measure. Aim: To investigate the factor structure of the German Pediatric Evaluation of Disability Inventory (PEDI-G) in a sample of typically developing children and children with an impairment. Material and Methods: An exploratory factor analysis (EFA) with factor rotation was performed to assess the factor structure for the PEDI-G domains (self-care, mobility and social function) of the Functional Skills Scale and the Caregiver Assistance Scale. Results: 262 children (118 (45%) girls and 144 (55%) boys) participated in this study. Their mean age (SD) was 4 years (SD 1.91). Results suggest that the PEDI domains of the Functional Skills Scale and the Caregivers Assistance Scale can be used as unidimensional measures to evaluate child s ability to perform activities of daily living. Conclusion: The results of this study support the use of the PEDI-G for research and practice in Austria, Germany and Switzerland. [ABSTRACT FROM AUTHOR]

Physical inactivity and peripheral muscle dysfunction are considered two of the main contributors to hospitalizations due to exacerbation and, above all, predictors of mortality for these requirements in patients with COPD. Therefore, longitudinal studies are needed to determine the impact of exacerbations during hospitalization on these two factors, especially after three months of hospital discharge. The objectives of the present study were to assess the level of physical activity in daily life (PADL) and isometric muscle strength of the quadriceps in patients hospitalized for exacerbation of COPD and to verify changes after 3 months of hospital discharge. This is a longitudinal observational study that assessed the PADL level with an accelerometer, after 24 h of the hospitalization and the beginning of the drug treatment and assessed the quadriceps muscle strength with a manual dynamometer, after 72 h of hospitalization, in 32 patients with COPD (66 ± 7.61 years), in addition to repeating both assessments with 30 days of hospital discharge and after 3 months of follow-up. Cognition, dyspnea, general health, physical performance and lung function were assessed to characterize the sample. As main results, there was increase in active time (344 ± 260 − 447 ± 199 min; p = 0.04) and number of steps (4.241 ± 374 − 6.216 ± 400 steps; p = 0.02) after three months. In addition, inactive time showed significant reduction 30 days after hospital discharge (1.151 ± 249 − 1.065 ± 198 min; p = 0.02). The level of physical activity showed significant improvement due to the increase in active time and number of steps after three months of hospital discharge and to the reduction of inactive time 30 days after hospital discharge. [ABSTRACT FROM AUTHOR]

Higher physical activity levels during hospitalization may benefit the life-space mobility, defined as the ability to move within environments that expand from one's home to the greater community, of stroke survivors following their discharge. This study aimed to evaluate the relationship between physical activity levels during rehabilitation hospitalization and life-space mobility among stroke survivors three months after their discharge. We recruited 84 stroke survivors as prospective participants from four convalescent rehabilitation hospitals. Physical activity levels during hospitalization were assessed using pedometers with a three-axis accelerometer, and their average step count over 14 consecutive days prior to discharge was used as the representative set of values. Pedometers were placed on the participant's waist or wrist on the non-paretic side. The Life-Space Assessment (LSA), a validated self-reporting measure for assessing community mobility, was implemented three months following participant discharge from rehabilitation hospitals via a mail-in survey method. To determine the relationship between the participants' level of physical activity during hospitalization and the LSA score following discharge, we performed multivariate regression analysis. A total of 75 participants (89.3%) completed the post-discharge survey and were therefore included in the analysis. The multiple regression analysis, controlled for age, balance function, walking endurance, fear of falling, and functional status, revealed that daily step counts were significantly associated with the LSA score three months after discharge (β = 0.241, p =.026). Physical activity levels during hospitalization were significantly associated with the life-space mobility of stroke survivors following discharge. [ABSTRACT FROM AUTHOR]

Background: Perhaps the most prevalent cause of anxiety among the elderly is the fear of falling, considering that a fall can lead to serious complications and decline of health. The purpose of this study was to examine the relationship between perceived social support and the fear of falling among people ages 60 and up. Methods: Upon completing informed consent, participants (n = 33) in assisted living facilities, living independently, or with a loved one completed a demographic questionnaire, the Falls Efficacy Scale-International and the Multidimensional Scale of Perceived Social Support. Results: There was not a statistically significant relationship between fear of falling and perceived social support (p =.14); however, there was a significant, strong positive correlation between age and fear of falling (r =.41, p =.05) and cane use and fear of falling (r =.54, p =.05). There were no statistically significant group differences in fear of falling (p =.48) for living status. There was a statistically significant difference in fear of falling between cane use (p =.001), with individuals using a cane reporting a significantly greater fear of falling (M = 48.21, SD = 12.95) than individuals not using a cane (M = 30.56, SD = 12.74). The results provide further insight into the relationship between fear of falling, perceived social support, cane use, and living status. Interventions and future research should examine the impact of social support and physical activity on fear of falling and reducing in cane use. [ABSTRACT FROM AUTHOR]

The benefits of advanced hydraulic microprocessor controlled knee (MPK) joints have been well established and repeatedly confirmed. The Genium knee was introduced in 2011 containing an enhanced control concept including additional sensors and improved algorithms enabling a range of new functions for transfemoral amputees (TFAs). A systematic review was conducted to evaluate the effect of the Genium knee on ambulation, mobility, activities of daily living (ADLs) and quality of life compared to standard MPKs. The review was conducted according to PRISMA Guidelines and Recommendations of the State-of-Science Evidence Report Guidelines of the American Academy of Orthotists & Prosthetists. Twelve articles were included in the review and reported primarily on active subjects (MFCL-3/4) transitioning from C-Leg to Genium knee systems. The overall validity of the evidence was medium to high with the exception of one article having low validity. Synthesis of biomechanical analyses concludes that gait during level walking, stairs and ramps is more physiological and symmetric following accommodation and use of the Genium in community ambulating TFAs. Further, sound side loading and compensatory motions are reduced. Transitioning from C-Leg to the Genium knee additionally resulted in significant improvements in mobility, quality of life and the performance in activities of daily living (ADLs). A high level of evidence was identified when assessing the ability of Genium to improve gait quality and safety and performance in ADLs. While individual studies report significant improvements in terms of quality of life and mobility, additional studies are needed to increase the evidence level. Microprocessor controlled prosthetic knees (MPKs) are well-established devices to serve patients with transfemoral amputation. Studies conducted mostly with the C-Leg MPK show that such knees significantly increase patient safety, ambulation, mobility, performance in activities of daily living and quality of life. Genium MPK includes advanced features which enable a range of new functions and functional benefits to patients. Transitioning from conventional MPKs (i.e., C-Leg) to Genium MPK resulted in more physiological gait, more equally distributed loading between the prosthetic and sound limbs, as well as reduced compensatory movements on the sounds side. These outcomes could potentially reduce the long-term risks of secondary physical complications in prosthetic users (i.e., osteoarthritis, osteoporosis). Genium significantly improved mobility, performance in activities of daily living, and quality of life in the patients using a conventional MPK (C-Leg). Different functioning principles of the MPKs presently available are responsible for different performance levels the knees offer to users. The amount of clinical evidence is also knee-dependent, with the C-Leg knee being most extensively tested in clinical studies. This systematic review concludes that Genium offers further advantages to transfemoral patients as compared to conventional MPKs (C-Leg). [ABSTRACT FROM AUTHOR]

To gain a deep understanding of the person, environment, and occupation-related self-management strategies used to overcome disabilities in daily living activities. In this concurrent transformative mixed method design guided by the Person, Environment, Occupation-Performance Model we assessed 12 older women functional disabilities using the PROMIS Physical Function Short Form 20, followed by in-depth interviews about their strategies for dealing with these disabilities. The sample's PROMIS mean T-score was below the national average. The sample predominantly used occupation-related strategies to overcome difficulties in daily living activities and these strategies were moderated by personal and cultural factors such as psychological and spirituality. The most frequently used strategy for self-care and instrumental activities of daily living were changing the method of performance and activity pacing for functional mobility. The strategies used by these participants can be used for the development of disability self-management interventions to increase Hispanic woman's function. [ABSTRACT FROM AUTHOR]

Frailty is an important medical syndrome that can be prevented or treated with specific interventions. However, there is limited research evidence on multifactorial perspectives of frailty management and its impact on daily function including mobility declines and changes in life-space mobility. Using the person-environment-occupation (PEO) model we aim to describe the relationship between frailty and life-space mobility in older adults. This manuscript provides a new framework for clinical practice and research implications of frailty and life-space mobility in older adults including: (1) overview of key concepts, (2) application of the PEO model to describe how frailty (personal) and life-space (environmental) can influence occupational performance, and (3) clinical practice implications to improve frailty-related immobility. This new framework provides a starting point to extend the focus of frailty beyond the individual to encompass the environmental context within which people live and move. [ABSTRACT FROM AUTHOR]

This article examines the experiences of students with mobility disabilities accessing higher education institutions in the Accra metropolis of Ghana. To capture the accessibility issues that people with disabilities encounter in their daily lives as postsecondary students first hand, this study used PhotoVoice methodology, which uses a combination of photographs and corresponding narrations. Themes identified in the photographs and narrations highlight the emotional and academic impact of participant encounters with an inaccessible postsecondary environment. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

More than 70% of elderly people age 80 and older are experiencing problems in personal mobility. Assistive robotics can represent a concrete support providing also a support for caregivers, clinicians and nurses by reducing their burden. A total of 20 older people and 34 caregivers (formal and informal) were interviewed in Italy and the Netherlands to investigate and prioritize their needs concerning the personal mobility domains and their attitudes towards assistive robots. The data were analysed from a user point of view by means of thematic content analysis by underlying recurrent topics. The results revealed four categories of needs from the perspective of the older individuals: instrumental needs, rehabilitation needs, personal safety and indoor activities of daily life. Additionally, the results underline how personal mobility issues influence different aspects of daily life. Complementarily, three categories of caregiver needs were also distinguished: instrumental needs, rehabilitation monitoring needs and checkup needs. The highest percentage of participants showed a positive expectation towards assistive robotics. The results were clustered according to the robot abilities (i.e., motion, interaction, manipulation, decision support and perception abilities) as a list of functional and technical requirements that should be developed to address all the needs related to the personal mobility. Robotic developer teams that work in this context could take advantage of this research. Additionally, this work can be used as a basis for clinicians and nurses working in geriatric units to understand how the robots can support and enhance their work. The incidence of personal mobility limitations affects 35% of adults age 70 and older and 72% of people over 80 years of age. Assistive robots can support elderly people during daily tasks: they could promote their personal mobility acting as a supporting tool. The results of the needs analysis revealed four categories of needs from the perspective of the older individuals: instrumental needs, rehabilitation needs, personal safety, and indoor activities of daily life. Three categories of caregiver needs were also distinguished: instrumental needs, rehabilitation monitoring needs, and check-up needs. [ABSTRACT FROM AUTHOR]

The assisted living (AL) environment plays an important role in supporting residents' satisfaction and helping them to age in place. The AL environment is multidimensional and has many interrelated components including staffing (e.g. direct care workers, nursing, activity staff), services provided (e.g. medical, mental health, pharmacy), amenities offered at the setting (e.g. beauty salon, library, exercise facilities), and the physical environment. Evidence suggests that aspects of the AL environment can enhance or detract from the physical function, well-being, social engagement, and behavioral outcomes among residents. The purpose of this study was to develop and test a multidimensional AL environment measurement model that includes indicators of staffing, services, amenities, and the physical environment. Baseline data was used from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 54 AL facilities across three states were included in the sample. Settings ranged in size from 31 to 164 beds with an average size of 82.2 (SD = 26.2) beds and the majority were for profit facilities (n = 41, 74.5%). Structural equation modeling was used to test the proposed model. Results showed that the model fit the data (χ2/df = 1.861, p <.05; CFI =.858, RMSEA =.126). Having a comprehensive AL environment measurement model will advance future research that explores the impact of the environment on resident outcomes. Findings from this study will inform interventions and programs designed to modify AL environments to optimize residents' satisfaction with AL. [ABSTRACT FROM AUTHOR]

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